To the Editor.—Someone needs to remind the frenzied "reformers" that the physician is one whose judgment plays a unique and irreplaceable role in the well-being of the human community. Have we really become so callous that we are even willing to compromise our patients by suggesting that a less qualified practitioner can do what only a qualified physician can do?To couch the argument for expanding the role of nurses, as Dr DeAngelis1 does, in the popular mantra of cost-effectiveness demeans the practice of medicine. Furthermore, I believe that many more doctors would practice in rural areas if they could earn a living. Big-city health maintenance organizations and hospital conglomerates, competing for a larger market share, have expanded into the rural areas and have all but destroyed private practice there. Expanding the role of NPs to allow independent practice for rural areas is no solution to the problem